Association between surgical delay and outcomes among patients with invasive cutaneous melanoma

Background: The relationship between surgical delay and outcomes for patients with cutaneous melanoma is understudied. The objectives of this study were to determine the impact of surgical delay on regional nodal involvement and mortality in patients with cutaneous melanoma. Methods: Retrospective study of patients diagnosed with clinically node-negative invasive cutaneous melanoma from 2004 to 2018. Outcomes included regional lymph node disease and overall survival. Multivariable logistic regression and Cox proportional-hazards models were constructed to adjust for pertinent clinical factors. Results: Of 423,001 patients, 21.8% experienced a surgical delay (>= 45 days). These patients were more likely to have nodal involvement (OR1.09; P = 0.01). Surgical delay (HR1.14; P < 0.001), Black race (HR1.34; P = 0.002), and Medicaid (HR1.92; P < 0.001) were associated with lower survival. Patients treated at academic/research (HR0.87; P < 0.001) or integrated network cancer programs (HR0.89; P = 0.001) had improve survival. Conclusions: Surgical delay was frequent and resulted in higher rates of lymph node involvement and decreased overall survival.